TY - JOUR
T1 - Factors associated with home delivery in rural Sindh, Pakistan
T2 - results from the global network birth registry
AU - Sadia, Afreen
AU - Mahmood, Shafaq
AU - Naqvi, Farnaz
AU - Naqvi, Seemab
AU - Soomro, Zahid
AU - Saleem, Sarah
N1 - Funding Information:
This study was undertaken as part of the Global Network for Women and Children’s Health Research (Global Network), a multi-country research network funded by the US National Institute of Child Health and Human Development (NICHD). The MNHR is a prospective, population-based observational study that includes all pregnant women, their newborns, and their outcomes in defined geographic communities (clusters). In these clusters, there are approximately 300 to 500 births annually. There are currently 8–10 clusters at each of the Global Network sites in western Kenya, Zambia (Kafue and Chongwe), the Democratic Republic of the Congo (DRC) (North and South Ubangi Province), Pakistan (Thatta in Sindh Provence), India (Belagavi and Nagpur), Guatemala (Chimaltenango) and Bangladesh (District Tangail). The MNHR was initiated at each of the study sites between 2008 and 2009, except for the DRC, which joined the Global Network in 2014, and the Bangladesh site which joined the Global Network in 2018. The objective of the MNHR study is to enroll pregnant women by 20 weeks gestation and to obtain data on pregnancy outcomes for all deliveries that take place within the community. Each community employs registry administrators (RAs) who are paid community health workers or nurses recruited from the local communities. Every RA identifies and tracks these pregnancies and their outcomes in coordination with community elders, birth attendants, and other healthcare workers. Follow-up visits are conducted after delivery and at 42-days post-partum. During the follow-up visit, in addition to pregnancy outcome, questions related to ANC visits are asked. Moreover, the provision of specific preventive care services such as the usage of vitamins/iron, tetanus toxoid (TT) vaccine, and HIV testing are also captured as binary responses. The research administrator at each site ensures the completeness and accuracy of the data collected at each site [, ].
Funding Information:
We are grateful to the HRP Alliance, and the entire team of Statistical Analysis Workshop held at World Health Organization Headquarters, Geneva, Switzerland for mentoring and giving training for the data analysis for this study. We are also thankful to the dedicated research staff and all the mothers who participated in the study. We are also thankful to the Eastern Mediterranean Hub of HRP Alliance at Aga Khan University to facilitate the data analysis.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - Background: According to global estimates for 2017, nearly 295,000 maternal deaths occurred worldwide. Thus, approximately 810 women die every day due to pregnancy-related complications. This burden of maternal deaths in LMICs is primarily due to poor healthcare service utilization, as indicated by relatively low rates of institutional deliveries and skilled-birth attendance (SBA). We conducted this study with an aim to assess the factors associated with home delivery and its subsequent effect on the pregnancy outcome in rural Sindh, Pakistan. Methods: Data for this study were taken from The Global Network’s Maternal Newborn Health Registry (MNHR), which is a prospective, population-based observational cohort study. Registry data for 2018–2019 for District Thatta, Pakistan was retrieved for the analysis. Multivariable logistic regression models were used to determine the effect of each independent variable on the place of delivery by including all predictors and covariates. Results of the regression analyses are presented with crude odds ratios (OR) and adjusted odds ratios (aOR) with 95% confidence intervals (CIs). Results: A total of 4649 women were included in the study, of these, 1286 (27.7%) women had delivered at home. Of those who delivered at home, a larger proportion was illiterate (90%), had a BMI of less than 18.5 kg/m2 (26.0%), had parity of 3 or more (48.1%), and had a history of pregnancy loss as compared to women who had institutional delivery. In addition, two-thirds of women (63.4%) who had delivered at home had less than 4 ANC visits, whereas 15.6% did not receive any ANC. On multivariable logistic regression we found that home delivery was significantly associated with being illiterate (aOR = 1.60; [95% CI: 1.34, 2.04]), having high parity (aOR = 1.91; [95% CI: 1.58, 2.32]), and no ANC visit (aOR = 14.8; [95% CI: 10.2, 21.5]). Conclusions: More than a quarter of our study sample women delivered at home. These women were illiterate, multiparous, and did not receive antenatal care during pregnancy. It is essential to conduct extensive educational interventions for the women and their family members regarding the potential benefits of delivering in a safe and skilled environment. Moreover, the provision of comprehensive and quality antenatal care should be ensured as it improves the mothers' health-seeking behavior and helps them make informed decisions about their health and well-being.
AB - Background: According to global estimates for 2017, nearly 295,000 maternal deaths occurred worldwide. Thus, approximately 810 women die every day due to pregnancy-related complications. This burden of maternal deaths in LMICs is primarily due to poor healthcare service utilization, as indicated by relatively low rates of institutional deliveries and skilled-birth attendance (SBA). We conducted this study with an aim to assess the factors associated with home delivery and its subsequent effect on the pregnancy outcome in rural Sindh, Pakistan. Methods: Data for this study were taken from The Global Network’s Maternal Newborn Health Registry (MNHR), which is a prospective, population-based observational cohort study. Registry data for 2018–2019 for District Thatta, Pakistan was retrieved for the analysis. Multivariable logistic regression models were used to determine the effect of each independent variable on the place of delivery by including all predictors and covariates. Results of the regression analyses are presented with crude odds ratios (OR) and adjusted odds ratios (aOR) with 95% confidence intervals (CIs). Results: A total of 4649 women were included in the study, of these, 1286 (27.7%) women had delivered at home. Of those who delivered at home, a larger proportion was illiterate (90%), had a BMI of less than 18.5 kg/m2 (26.0%), had parity of 3 or more (48.1%), and had a history of pregnancy loss as compared to women who had institutional delivery. In addition, two-thirds of women (63.4%) who had delivered at home had less than 4 ANC visits, whereas 15.6% did not receive any ANC. On multivariable logistic regression we found that home delivery was significantly associated with being illiterate (aOR = 1.60; [95% CI: 1.34, 2.04]), having high parity (aOR = 1.91; [95% CI: 1.58, 2.32]), and no ANC visit (aOR = 14.8; [95% CI: 10.2, 21.5]). Conclusions: More than a quarter of our study sample women delivered at home. These women were illiterate, multiparous, and did not receive antenatal care during pregnancy. It is essential to conduct extensive educational interventions for the women and their family members regarding the potential benefits of delivering in a safe and skilled environment. Moreover, the provision of comprehensive and quality antenatal care should be ensured as it improves the mothers' health-seeking behavior and helps them make informed decisions about their health and well-being.
KW - Global Network
KW - Home delivery
KW - Maternal Factors
KW - Pakistan
KW - Rural Populations
UR - http://www.scopus.com/inward/record.url?scp=85126079570&partnerID=8YFLogxK
U2 - 10.1186/s12884-022-04516-2
DO - 10.1186/s12884-022-04516-2
M3 - Article
C2 - 35260085
AN - SCOPUS:85126079570
SN - 1471-2393
VL - 22
JO - BMC Pregnancy and Childbirth
JF - BMC Pregnancy and Childbirth
IS - 1
M1 - 192
ER -